Camp Loyaltown Donation Form:

Gift & Payment Information

Honor and Memorial Gifts to Camp Loyaltown

With a gift of $15 or more, we will send a memorial card or a card to mark a special occasion—birthday, anniversary, graduation or wedding, for example—to a recipient you designate. The cards feature artwork created by people supported through our programs, and note that a contribution has been made to Camp on your behalf (the amount of the donation does not appear on card.)

Each year more than 600 campers enjoy the outdoors in a safe and fun environment. Your gift will support Camp Loyaltown and its mission of providing fun-filled camp experiences for children and adults with intellectual and develepmental disabilities in a loving, supportive and safe environment.

Field Is Required Select Gift Amount:

$500.00

$250.00

$100.00

$50.00

$25.00

Enter an Amount:

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Comments

Honor / Memorial Information

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Send Notification of my donation to:

(An acknowledgemet card created by a person supported through our programs will be sent to the Recipient listed below. The amount of the donation does not appear on the card.)

Notification Recipient Title:

Notification Recipient First & Last Name:

Recipient Relationship to Honoree or Deceased (spouse, mother, sister):

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State/Province:

Notification Recipient ZIP/Postal Code:

If you donate and have not already registered, you will receive periodic updates and communications from AHRC Nassau.

Billing Information

Is this donation on behalf of a company or employer?

Yes

Company / Employer Name:

Title:

First Name:

Last Name:

Email Address:

Street 1:

City:

State/Province:

ZIP/Postal Code:

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?